Ninomiya T, Perkovic V, Gallagher M, Jardine M, Cass A, Arima H, Anderson C, Neal B, Woodward M, Omae T, MacMahon S, Chalmers J
George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia.
Kidney Int. 2008 Apr;73(8):963-70. doi: 10.1038/ki.2008.5. Epub 2008 Feb 13.
Recent epidemiological studies have shown a J-shaped association between the risk of stroke and systolic blood pressure (SBP) levels in people with chronic kidney disease (CKD). The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) was a randomized, placebo-controlled trial demonstrating that perindopril-based blood pressure (BP) lowering reduced the risk of stroke in 6105 participants with prior cerebrovascular disease. We estimated the effects of therapy on the risk of recurrent stroke in 1757 of these participants with stage 3 or greater CKD according to baseline BP and the relationship between achieved follow-up BP and the risk of stroke. Active therapy produced comparable and significant reductions in the risk of stroke across all baseline SBP levels. The age- and gender-adjusted incidence of stroke increased significantly in a log-linear relationship for achieved SBP levels and strokes per 1000 person-years. This association persisted after adjusting for potential confounding factors. We found that perindopril-based BP lowering effectively prevented recurrent stroke in people with CKD, across a wide range of BP levels, without evidence of an increased risk of stroke in people with low BP levels.
近期的流行病学研究表明，在慢性肾脏病（CKD）患者中，中风风险与收缩压（SBP）水平呈J形关联。培哚普利预防复发性中风研究（PROGRESS）是一项随机、安慰剂对照试验，表明以培哚普利为基础降低血压可降低6105例既往有脑血管疾病参与者的中风风险。我们根据基线血压以及随访时达到的血压与中风风险之间的关系，估计了治疗对其中1757例3期或更严重CKD参与者复发性中风风险的影响。在所有基线SBP水平上，积极治疗均使中风风险显著降低且效果相当。对于随访时达到的SBP水平和每1000人年的中风发生率，经年龄和性别调整后的中风发生率呈对数线性关系显著增加。在调整潜在混杂因素后，这种关联仍然存在。我们发现，以培哚普利为基础降低血压可有效预防CKD患者复发性中风，涵盖广泛的血压水平，且没有证据表明低血压水平患者中风风险增加。
